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Evaluation of a new visual uptake scoring scale for 18F-fluorothymidine positron emission tomography in the diagnosis of pulmonary lesions

Beauregard, Jean-Mathieua,e; Giraudet, Anne-Laurea,c; Aide, Nicolasa,d; Hofman, Michael S.a; Blum, Robertb; Drummond, Elizabetha; Roselt, Petera; Hicks, Rodney J.a

Nuclear Medicine Communications: June 2013 - Volume 34 - Issue 6 - p 521–526
doi: 10.1097/MNM.0b013e3283606669
Original Articles

Purpose The aim of this analysis was to evaluate a new visual scoring scale developed to facilitate the qualitative appraisal of lesion uptake on 18F-fluorothymidine PET (18F-FLT-PET).

Methods Sixty-two patients with a pulmonary lesion of unknown aetiology who had undergone an 18F-fluorodeoxyglucose-PET/computed tomography (CT) suspicious for malignancy prospectively underwent an 18F-FLT-PET/CT. Three nuclear medicine physicians independently reviewed each 18F-FLT-PET/CT scan with knowledge of the location of the pulmonary lesion but blinded to the final diagnosis. They scored the lesion 18F-FLT uptake as follows: (0) no visible uptake; (1) <spleen; (2) ≥spleen, but <both liver and marrow; (3) between liver and marrow; (4) >liver and >marrow. Lesion mean (SUVmean) and maximum (SUVmax) standardized uptake values were measured in a separate session.

Results In all, 35 lesions were malignant and 27 were benign, as assessed on the basis of surgery, biopsy or follow-up of at least 12 months. Visual score, SUVmean and SUVmax were statistically different between benign and malignant lesions. The visual scoring scale showed substantial to almost-perfect interobserver agreement with a weighted κ value of 0.84, 0.67 and 0.65 for each observer pair. The visual score was highly correlated to SUVmean and SUVmax (r=0.83 and 0.87, respectively) and described a logarithmic pattern in relation to SUVmean and SUVmax (r 2=0.67 and 0.72, respectively). The area under the receiver-operating characteristic curve for the visual score was 0.86 and was statistically different from that for SUVmean (0.77; P=0.026) and SUVmax (0.79; P=0.047).

Conclusion The 18F-FLT scoring scale we propose is easy to use with high interobserver agreement and a significantly better discriminative capacity compared with SUV measurements. It has the potential to harmonize the qualitative interpretation of 18F-FLT-PET/CT in lung cancer diagnosis.

aMolecular Imaging, Centre for Cancer Imaging, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne

bMedical Oncology, Bendigo Health, Bendigo, Australia

cNuclear Medicine Service, Hôpital René Huguenin – Institut Curie, Paris

dDepartment of Nuclear Medicine, Centre François Baclesse, Caen, France

eDepartment of Medical Imaging, CHU de Québec, Laval University, Quebec City, Quebec, Canada

Correspondence to Jean-Mathieu Beauregard, MD, MSc, FRCPC, CHU de Québec Research Center, 9 McMahon St., Quebec City, QC, Canada G1R 3S3 Tel: +1 418 525 4444; fax: +1 418 691 2922; e-mail:

Received November 8, 2012

Accepted February 20, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins